Leicester telehealth pilot shows significant reduction in admissions

Following renewed controversy over impact of assistive technologies, CCG reports major savings among COPD patients

Fresh evidence of the positive impact of telehealth technology was revealed this week with the report that a 12-month health coaching service averted 22 hospital admissions among a group of just 30 patients in the first seven weeks of deployment.

Announced at the end of a month that has seen renewed criticism of the Government’s plan to invest heavily in assistive technologies, the results of the scheme in Leicester are being welcomed by suppliers.

We wanted to be able to give our patients access to qualified, specialist advice services to shift the balance and focus from a model that responds to illness to one that promotes health and well-being

Run by Leicester City Clinical Commissioning Group (CCG) and delivered by Totally Health, the project targeted patients suffering from chronic obstructive pulmonary disease (COPD). Since its launch, the health coaching and telehealth service averted 22 hospital admissions across this group of patients in just seven weeks, throwing weight behind government claims that widespread deployment of the technologies would result in millions of pounds worth of savings, as well as improve patients’ lives and general wellbeing.

An admission is qualified as ‘averted’ based on a measure of the respiratory specialist nurse and/or the health coach providing an intervention to support the individual patient to manage their condition, to the extent that without this clinical support the patient would have been admitted. If the patient is not admitted for a period 14 days, after the 14th day the intervention is classified as a saved hospital admission.

Totally Health is providing Leicester City’s selected COPD patients with a two-way health coaching service that supports the local care pathway and local primary and acute care providers.The health coaches are registered nurses who help patients manage their conditions by providing mentoring and support via phone calls and telehealth monitoring.

Currently, a single unscheduled hospital admission through A&E at the CCG’s current Payment by Results tariff is Ł4,066. The number of patients recruited to the COPD wider change management programme had an average of 3.49 unscheduled hospital admissions during the previous 12 months. Prior to the programme being launched in December 2012, Leicester City had set a target of 70 unscheduled admissions to be averted during the whole 12-month period.

The early success of the programme is an indication that health coaching, combined with telehealth monitoring and the integration within our local care pathway really works to support people to engage in behavioural awareness and change for chronic disease prevention, chronic condition self management and rehabilitation

Emma-Jane Roberts, programme manager at Leicester City CCG, said: “We wanted to be able to give our patients access to qualified, specialist advice services to shift the balance and focus from a model that responds to illness to one that promotes health and well-being.

“The early success of the programme is an indication that health coaching, combined with telehealth monitoring and the integration within our local care pathway really works to support people to engage in behavioural awareness and change for chronic disease prevention, chronic condition self management and rehabilitation.”

The health coaching service is built on proven research methods, which can be seen in a trial reported in The New England Journal of Medicine 2010 by Dr David Wennberg and colleagues. The study looked at 174,120 subjects to assess the effect of telephone care-management strategy on medical costs and resource utilisation. The primary outcome measures at the end of 12 months were total medical costs and the number of hospital admissions. The results of the study demonstrated that the intervention reduced hospital admission by 10.1%, creating significant cost savings.

The programme is testament to how services external to the NHS and those within it can be integrated successfully to not only deliver high-quality care to patients, but, when managed appropriately within the local care pathway, can transform the way in which patients with long-term conditions are managed pro-actively

The service is also being used to deliver the Shared Decision Making programme under the QIPP Right Care Programme. Leicester City CCG’s COPD health coaching programme utilises the LUCY system for long-term condition management, combined with access to a COPD Patient Decision Aid (PDA) which has been developed by Totally Health. The system enables the information the nurses take in through health coaching, plus any data that arrives through telehealth monitoring, to be entered into an integrated system so the health coach can be alerted to anything that looks out of range and can send a notification via data transfer across the NHS N3 secure system to the relevant GP or hospital consultant linked to the patient. It also provides a valuable alternative and an opportunity for patients to discuss the longer-term management and implications of their condition, and the care options available to them.

Roberts said: “The programme is testament to how services external to the NHS and those within it can be integrated successfully to not only deliver high-quality care to patients, but, when managed appropriately within the local care pathway, can transform the way in which patients with long-term conditions are managed pro-actively.

“For example, when the bad weather and snow hit early in January, through the health coaching service we were able to give the patients we identified as being most at risk pro-active advice on what to do. It has really helped individuals feel involved and in control which improves self-esteem and can elevate self-efficacy.”

Professor Azhar Farooqi, GP and chairman of the CCG, added: “The success of this new system is fantastic news for patients.We fully support innovation and working with service providers outside of the NHS to help us deliver the enormity of the long-term conditions agenda.”

And Dr Durairaj, a GP and lead for COPD, told BBH : “Our patients get the support of managing their own condition at home. We know patients are happier and recover quicker when their care is managed at home and we are really pleased that the scheme is working and the project has enabled patients to avoid an A&E stay.”